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Going to the Gynecologist

Have you ever been to an obstetrician/gynecologist or Ob/Gyn for a pelvic exam and Pap test? If your answer is “no” and you are 21 or older, pick up your phone today and make an appointment with your doctor or a family planning clinic in your area. On the other hand, if your answer is “yes,” then how long has it been since your last Pap smear and pelvic exam? All women should have annual Pap smears beginning at age 21, according to the American College of Obstetricians and Gynecologists. Women 21 to 29 should get a Pap every year, then every other year (or as often as your doctor recommends) from ages 30 to 64.

See: How To Prepare For Your Pap Smear
When Do Women Need Pelvic Exams?
Teenage girls should see an OB/GYN between the ages of 13 to 15. While pelvic exams are rarely required during this first visit, this visit helps to establish a relationship with the doctor of your choice and to go over your medical and sexual history (even if you have not had sexual intercourse.) This is a good time to ask questions about sexually transmitted diseases and contraceptives.

Should I Be Tested For STDs?

You should always see your gynecologist if you experience:

any unusualy and/ or persistent vaginal discharge,
bleeding between periods,
or bleeding after sexual intercourse.

While a yearly Pap smear is not, in most cases, necessary after age 30, all women still require an annual pelvic exam to check for any other changes or infections. If you’ve had an HPV test that was negative that doesn’t mean you don’t need to have a yearly pelvic exam. The ACOG established these guidelines with full knowledge that HPV causes cervical cancer.

Did you know that with each new sexual partner your risk of getting HPV increases by 15 percent? This means that having multiple sex partners raises your risk of HPV substantially. According to the ACOG guidelines for Pap testing women diagnosed with HIV or other diseases or conditions that lower immunity should continue having annual Pap smears after age 30.

Fact: The greatest single reason for the occurrence of cervical cancer is not having Pap smears according to recommended guidelines.

The majority of women diagnosed with cervical cancer have not had a Pap smear in five or more years. Sadly, these women are usually at an advanced stage of cancer when they receive diagnosis.

No, several circumstances may occur during the rest of the year. Consult your Ob/ Gyn whenever you experience abnormal signs and symptoms. These signs and symptoms include:

Pelvic pain or menstrual cramps severe enough to disrupt your daily routine for even a few days a month.
Abnormal bleeding occurs you must change sanitary napkins, tampons, or other menstrual products more often than once every two to three hours.
Bleeding between periods.
Any unusual discharge, pain, swelling, or itching of you vagina or lower abdomen.

Any of these symptoms can indicate a vaginal infection or sexually transmitted disease or STD which could affect your future fertility. They may also indicate other diseases such as:

endometriosis,
pelvic inflammatory disease,
or a number of other reproductive disorders.

Of course, if you think you are pregnant, see your healthcare provider as soon as possible to help ensure a healthy pregnancy and healthy baby.

Also see your gynecologist more often if:

you plan of getting pregnant,
you think you may have a sexually transmitted infection or have a partner who has STI,
have a history of sexually related illness,
or have a mother or sister who developed breast cancer before menopause.

Consult your healthcare provider, if you notice any changes in your breasts such as puckering, dimpling, or other changes to the skin of your breasts; have newly retracted nipples, or discharge from your nipples, not associated with breast feeding; if there is any change in your breast size or shape; or if you experience an increase in breast pain, discomfort or emotional issues before your period.

The best time to schedule your annual pelvic exam and to obtain the most accurate results from your gynecological examination and annual Pap smear is one or two weeks after your period.

Vaginal Douching is never a good idea, because of the risk of infection it presents. It is particularly important not to douche for at least two or three days before you see your gynecologist. You also should refrain from sexual intercourse for at least 24 hours prior to your examination.

Make sure to empty your bladder just before your exam for a more comfortable examination. You may also want to keep a health diary that you can go over with your doctor during your appointment. You can use a calendar to keep track of your periods, any pain experienced, discharges, or other symptoms that occur during the month.

If you’re annual pelvic exam is the only doctor you see on a regular basis, as it is for 24 percent of women, your gynecologist may order routine tests, such as urinalysis, cholesterol, and blood sugar levels, as well as others.

What Happens During an Annual Pap Test and Pelvic Exam?

The first thing that usually happens during your annual exam is getting checks of your blood pressure, weight, pulse, and often urine. Be prepared to give the nurse the date of your last period — this is the date of the first day of your last period. Also go over any concerns that you want to discuss with the doctor.

After your initial discussion with the nurse, you’ll be directed to take all of your clothes off (you may leave your socks on.) Most gynecologists provide a short examination gown and a paper sheet to cover yourself until your examination begins. When you’re finished, and sitting on the exam table, your gynecologist comes in, accompanied by the nurse. A female nurse should always be present during your annual exam, particularly if your gynecologist is male. The presence of the nurse provides protection for both you and your gynecologist. Your physician will listen to your heart and lungs, check your breasts for any changes or lumps, and palpitate your abdominal area for any irregularities. A reliable examination of your breasts takes approximately 30 seconds per breast.

During your breast examination your physician should discuss monthly breast self- exam with you and also provide instructions if you are unfamiliar with how to perform BSE. If you are 35 or older, your physician should also discuss mammogram screening for breast cancer.

During the pelvic exam/ Pap smear portion of your visit, you’ll need to lay down on the table and put your feet in the stirrups. You may need to scoot down to the end of the table and spread your knees apart. Next a speculum is inserted into your vagina to hold your vaginal walls open so your physician can view the inside of the vaginal walls and the cervix, and collect a sample of cervical tissue for your Pap test.
What is the Procedure for Collecting a Pap Smear Sample?
Obtaining the Pap smear requires that your gynecologist insert a long cotton swab into your vagina. The cotton swab gently swabs against your cervix so that a sample of cervical cells is retrieved for evaluation by a pathologist. Labs generally require about five days for your test results to return to your gynecologist.
What if My Pap Smear Is Abnormal?
In the unlikely event that your Pap results are abnormal, the first thing you should not do is jump to the conclusion that you have cancer. In the majority of abnormal Pap smears, the cause is not cervical cancer, but one of a variety of other causes that include inflammation, the presence of blood or sperm, or an infection such as a vaginal yeast infection or bacterial vaginosis, and sometimes the presence of an undiagnosed sexually transmitted diseases.

Try to remember that the Pap smear is not a diagnostic tool — it does not diagnose cancer or any other disease. The Pap test is a screening tool that indicates whether further evaluation is necessary. If you receive abnormal Pap results your gynecologist may recommend a follow-up Pap test in three to six months. Or other options for further testing such as colposcopy or the LEEP may also be recommended.

Another part of your annual pelvic exam is called a bimanual exam. This test is performed when your gynecologist inserts two fingers into your vagina and places the other hand on top of your lower abdomen, while feeling for any abnormalities that might have occurred since your last pelvic exam. During this part of your examination, your doctor checks the size, shape, and mobility of your uterus. Changes in your ovaries, such as ovarian cysts may be detected during the bimanual exam, as well as other uterine changes including endometriosis, fibroid tumors, or other common uterine conditions.

Women, forty and older need a colorectal exam, as well as a fecal blood occult test for possible changes in your colon. If your GYN does not do this, you should ask him to perform this possibly lifesaving examination.

When the examination portion of your appointment is complete, your gynecologist will go over your health diary and answer any questions you have. This is when you should tell your gynecologist about the timing and frequency of any illness or other condition you might have experienced since your last appointment. Also make sure to include information about whether you have experienced irregular periodsor painful periods, or any other menstruation menstrual problems, vaginal infections, or painful sexual intercourse.

Other health issues to discuss include any dramatic weight change, hair loss or skin changes.